Breast cancer is the most common malignancy in the female population, the second leading cause of death from cancer, after lung cancer, and the most common cause of death in women aged 40 to 55 years.

It is estimated that during a woman’s lifetime the probability of developing MS reaches 12-13%. That is, approximately 1/8-9 women will be affected by breast cancer at some point in their lives. This percentage refers to women of average risk, who make up the majority of cases, the so-called sporadic cancer. However, there are other population groups, the so-called high-risk groups in which the probability of occurrence is significantly higher and therefore need a different and individualized approach both at the level of prevention and at the level of treatment.

Prevention is based on a simple examination, the mammogram. Prevention is divided into primary, secondary and tertiary.

There is no primary prevention in breast cancer. Avoiding alcohol, smoking and maintaining a normal body weight is recommended.

Mammography as a means of secondary prevention has proven benefit as studies have shown that mortality from MS in women has decreased by 39% from 1989 to 2015.

In clinical practice, the use of mathematical models helps to calculate the probability of occurrence of AF as well as to classify patients at medium or high risk. The most common model used is the modified Gail 2 model or NCI Breast Cancer Risk Assessment Tool.

It is worth mentioning that in selected cases (e.g. dense mammographic breasts) the test must be completed with a breast ultrasound. In addition, tomosynthesis is gaining more and more ground in the preventive screening of women, especially those with dense breasts. Dense breasts have been found to be an independent risk factor for the development of MS and reduce the sensitivity of mammography.

In recent years, artificial intelligence has been applied to early diagnosis (mammography) while efforts are being made to apply it to treatment and prognosis.

Regarding him preventive control in average risk patients this consists of:

• Annual checkup with digital mammography from the age of 40
• Clinical examination of the breast should be part of the preventive check-up and should be done every 3 years approximately for women between the ages of 20 and 30, and every year for women aged 40 and older

On the contrary, in high-risk patients such as in the following cases:

• Personal history of lobular cancer in situ, atypical hyperplasia or breast cancer
• Age ≥35 years and 5-year probability of occurrence with Gail model risk ≥ 1.7%
• Probability of occurrence during the lifetime of the patient with Gail model risk > 20%
• Extremely dense breasts in a mammographic examination
• People with a known mutation in the BRCA1 or BRCA2, PTEN, TP53 genes
• A first-degree relative with a BRCA1/BRCA2 mutation
• Familial syndromes
• Personal history of previous chest radiation between the ages of 10-30 years
• Treatment of lymphoma

The preventive check consists of:

• Clinical examination every 6-12 months from the age of 25 or 10 years before the age of onset of MS in the youngest relative
• Annual checkup with MRI from 25 years and addition of annual mammography from 30
• Breast ultrasound on impossibility of performing MRI and as a complementary examination of mammography (dense breasts)

Women at high risk of developing breast cancer (such as family history, genetic predisposition, individual history of MS) ​​should discuss with their doctor the benefits and limitations of earlier initiation of mammography screening, the need for additional tests (e.g. .eg magnetic resonance imaging) or increasing the frequency of examinations. In addition, in this population the potential benefits of chemoprophylaxis (estrogen blockade – at least 50% reduction in the probability of hormone-dependent MS) and prophylactic bilateral mastectomy (90-95% reduction in the probability of MS) ​​should be discussed with or without rehabilitation for cases of patients who are carriers of pathogenic gene mutations (eg BRCA1/2).

We should point out the importance of a clinical examination by a fully qualified physician, who will direct the patient and determine the type of preventive examination.

In addition to improving survival, preventive screening also increases the possibility of breast conservation as it can detect smaller, non-palpable lesions in the breast.

October is dedicated to breast cancer awareness, let’s highlight the importance of prevention and early diagnosis! Take care of your body, because health starts with you!